Authors
Zharikov A.N.1, Aliev A.R.1, Kozlov A.V.2, Anchugina D.А.2, Vlasov K.E.2, Nikolenko D.A.1, Bondarenko D.S.1
1 Altai State Medical University, Barnaul
2 Regional Clinical Hospital, Barnaul
Abstract
Backgraund. Postoperative complications arising after operations for complicated and uncomplicated aneurysms of the infrarenal aorta are a complex surgical pathology with a high mortality rate.
Aims. To study the results of surgical treatment of complicated and uncomplicated aneurysms of the infrarenal aorta and evaluate the effectiveness of approaches to the diagnosis and treatment of postoperative complications.
Materials and Methods. The surgical treatment of 51 patients with abdominal aortic aneurysms was evaluated. Two groups of patients were identified: Group 1 (n = 21) – those admitted urgently with complicated aneurysms (rupture, dissection); Group 2 (n = 30) – those admitted electively and with uncomplicated aneurysms. According to MSCT angiography, the size of abdominal aortic aneurysms in elective patients was 57,8±3,7 mm, while in emergency patients, it reached 68,0±2,1 mm (p = 0,012). In both groups, linear and aortic-bifurcation grafting techniques were used for surgical treatment. Postoperatively, the diagnosis and treatment of complications were assessed.
Results. Aneurysmectomy with linear grafting was performed in 4 cases in patients in the first group (19%) and in 4 cases (13,3%) in the second group. Aneurysmectomy with bifurcation aortic grafting was recorded in 17 (81%) cases in the first group and 26 (86,7%) in the second. Of the 51% of postoperative complications observed in both groups, they were recorded 34,7% more often in the first group. The mortality rate was 36,2% higher (p<0,001), with a combined mortality rate of 21,6% (11 patients) in both groups.
Conclusion. Severe complications of surgical treatment of abdominal aortic aneurysms include dynamic intestinal obstruction, abdominal compartment syndrome, acute kidney injury, and ischemic colitis, which are most common in complicated cases. A comprehensive preoperative examination, including CT angiography, adherence to intraoperative revascularization procedures, intra-abdominal pressure monitoring, postoperative colonoscopy, and timely reoperation using vacuum systems in the postoperative period enable successful management.
Keywords: аbdominal aortic aneurysms, aneurysmectomy, postoperative complications, intra-abdominal hypertension, ischemic colitis, intestinal intubation, vacuum therapy.
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